GIFT  OF 
Mrs. William  L.Cook 


HAT    YOU    SHOULD    KNOW 
ABOUT  TUBERCULOSIS 

FSEFUL    FACTS    FOR    THE    TUBERCULOUS    AND 
THOSE  LIVING  WITH  THEM 


PREPARED  BY 
THE    NATIONAL    TUBERCULOSIS    ASSOCIATION 


381  FOURTH  AVENUE,  NEW  YORK 


AMERICAN   MEDICAL  ASSOCIATION 

FIVE  HUNDRED  AND  THIRTY-FIVE  NORTH  DEARBORN  STREET 
CHICAGO 


PREFACE 


There  is  today  among  the  public  a  great  amount  of  misinfor- 
mation and  misunderstanding  about  tuberculosis,  a  misinforma- 
tion and  misunderstanding  which  has  many  bad  results,  partly 
by  causing  sufferers  with  this  disease  to  live  unwisely  and  to  do 
things  which  are  harmful  to  them,  partly  by  causing  the  public 
to  be  unnecessarily  afraid  of  infection  and,  therefore,  making 
them  look  upon  those  who  are  afflicted  with  this  disease  with 
needless  fear.  What  is  needed,  if  tuberculosis  is  to  be  con- 
quered in  this  country,  is  a  better  knowledge  by  the  public  of 
what  this  disease  is  and  what  the  patients  themselves  and  their 
friends  can  do  to  combat  it. 

The  National  Association  for  the  Study  and  Prevention  of 
Tuberculosis  realizes  that  the  only  way  to  remove  such  misin- 
formation is  by  the  dissemination  of  accurate  knowledge  on  the 
subject.  The  following  pages  have  been  written  with  the  aim 
of  making  plain  to  the  layman  what  he  can  do  if  he,  or  one  he 
loves,  has  developed  this  disease.  This  booklet  contains  the 
essential  facts,  and  if  its  teachings  are  taken  to  heart  and  its 
directions  are  carefully  followed,  it  should  do  much  to  bring 
about  the  early  discovery  and  the  successful  treatment  of  this 
prevalent  trouble. 

In  any  book  destined  for  popular  instruction  a  certain 
amount  of  repetition  is  essential  if  certain  important  details  are 
to  be  impressed  upon  the  minds  of  the  readers,  and  it  is  hoped 
that  such  repetitions  as  are  found  in  this  booklet  will,  for  this 
reason,  be  pardoned. 

CHARLES  L.  MINOR,  M.D.,  Chairman, 

Asheville,  N.  C. 
DAVID  R.  LYMAN,  M.D., 

Wallingford,  Conn. 
WILLIAM  H.  BALDWIN, 

Washington,  D.  C. 
H.  R.  M.  LANDIS,  M.D., 

Philadelphia,  Pa. 
JOHN  H.  LOWMAN,  M.D., 

Cleveland,  Ohio. 
Committee  on  Educational  Pamphlet  of  The  National 

Association  for  the  Study  and  Prevention  of  Tuberculosis. 


fr  o  /*  A  i~  i— 


USEFUL  FACTS 

FOR  THE  TUBERCULOUS  AND  THOSE 
LIVING  WITH  THEM 


I.  DO  YOU  VALUE  YOUR  HEALTH? 

If  so,  what  follows  will  interest  you;  read  it  carefully;  it  will 
pay  you. 

II.  WHY  ARE  PEOPLE  AFRAID  OF  TUBERCULOSIS? 

Because  every  third  person  between  fifteen  and  sixty  dies  of 
it,  or  every  fourth  person  between  twenty  and  fifty ;  or,  in  other 
figures,  it  kills  about  one  in  ten  of  all  people  who  die  at  any 
age.  Also  because  it  disables  and  renders  useless  and  helpless 
those  who  have  it,  and  is  often  the  means  of  beggaring  their 
families. 

III.  WHY  SHOULD  YOU  BOTHER  YOURSELF 
ABOUT  IT  IF  YOU  ARE  NOT  SICK  WITH  IT? 

Because  you,  or  some  of  your  family,  may  develop  it  at  any 
time ;  therefore,  by  knowing  something  about  it,  you  can  greatly 
lessen  the  chance  of  getting  it,  or,  should  you  get  it,  can  lessen 
its  danger  to  yourself  and  your  children.  Further,  every  man 
and  woman  worth  the  name  wants  to  help  others  who  are  jn 
trouble.  This  pamphlet  will  teach  you  how  to  do  that. 

IV.  WHAT  IS  TUBERCULOSIS? 

Tuberculosis  is  a  disease  caused  by  the  growth  in  your  lungs, 

or,  less  commonly,  in  other  parts  of  your  body,  of  a  minute 

T  microscopic    fungus-,  plant,   or.  germ  called   the 

and  if C  r  ^     tubercle    bacillus.      This    germ    produces    and 

throws    off    poisons    which    kill    the    structures 

around  it.     Multiplying  by  division,  it  spreads, 

slowly  or  rapidly,  through  the  whole  lung  until  finally  it  kills 

the  person  in  whom  it  grows.    In  recent  years  it  has  been  shown 

that  the  germ  frequently  gets  into  the  body  in  childhood,  but, 

since  it  does  not  grow  easily  in  the  human  body,  many  of  these 


germs  are  killed  at  once  by  the  tissues.  Others  lie  inactive  for 
a  long  time  in  the  glands  in  the  chest  and  do  not  develop  until 
by  some  chance  the  resisting  power  of  the  body  is  lowered  suf- 
ficiently for  the  germ  to  begin  to  grow,  the  thoroughly  healthy 
body  not  being  a  favorable  growing  place.  Overwork,  dissipa- 
tion, dark  dirty  homes  or  work-places,  bad  or  scanty  food,  late 
hours,  drunkenness,  and  certain  sicknesses  such  as  grippe, 
measles,  whooping  cough,  pneumonia  and  typhoid  fever,  and 
also  frequent  and  closely  repeated  pregnancies,  weaken  the  body, 
give  the  germ  the  opportunity  it  needs,  and  enable  it  to  develop. 
In  bodies  thus  weakened,  the  germ  can  flourish,  and,  if  they  are 
not  strengthened  in  time  by  proper  living,  the  disease  will 
advance.  This  advance  is  usually  slow  and  gradual,  so  that 
the  patient  may  live  from  two  to  ten  years,  but  in  the  more 
rare  galloping  form  its  advance  is  rapid,  so  that  the  patient 
dies  in  from  six  weeks  to  a  year. 

Fortunately  for  us  the  germ  of  tuberculosis  does  not  grow 
easily  in  the  human  body.     All  animals  have  a  certain  degree 

of  resistance  to  the  attack  of  the  germ.  In  some 
What  is  re-  this  resisting  power  is  very  low;  in  some  very 
sistance?  high-  The  guinea  pig,  for  example,  has  almost 
!  no  resistance  to  this  disease,  while  the  goat  has 
so  high  a  resistance  that  it  is  very  hard  to  infect  it  at  all.  Among 
human  beings  the  Indian  and  the  Negro  usually  show  a  very 
low  resisting  power,  and  when  infected,  are  apt  to  have  the 
rapid  and  dangerous  form  of  the  trouble.  The  average  white 
man  on  the  contrary  has  considerable  .resisting  power,  and  it 
takes  repeated,  prolonged  exposure  and  unfavorable  conditions 
o'f  working  and  living,  to  infect  him,  except  in  early  childhood, 
when,  it  should  never  be  forgotten,  infection  is  very  easy. 

The  first  manifestation  of  the  activity  of  the  germ  in  the 
body  is  the  formation,  usually  in  the  lungs,  of  a  small  gray 

lump,  which  we  call  a  tubercle.     This  is  about 

h  e  G  e  r  m     the  size  of  the  head  of  a  pirij  and>  examined 

,onquc  ing     uncjer  a  microscope,  it  is  seen  to  consist  of  a 

T~  cheesy  mass  of  dead  tissue  with  germs  lying  in 

it.  The  formation  of  this  dead  tissue  by  the 
poisons  of  the  germ  is  called  "Caseation."  Surrounding  the 
cheesy  center  is  a  double  layer  of  cells  thrown  out  by  the  body 
to  protect  itself  from  the  invading  germ.  If  the  poisons  of  the 
germ  are  sufficiently  strong,  or  if  the  cells  surrounding  the 
germ  are  sufficiently  weak,  they  too  will  be  destroyed,  and  by 


degrees  successive  layers  of  tissue  will  be  killed,  the  trouble 
thus  spreading  at  the  outer  border  through  larger  and  larger 
areas  of  tissue  until  finally  the  whole  lung  is  involved.  When 
the  mass  of  dead  tissue  reaches  an  air  tube  it  is  coughed  up  and 
leaves  a  small  cavity  behind.  When  this  cavity  becomes  bigger, 
other  sorts  of  germs  from  the  outside  air  may  get  into  it  and 
help  the  tubercle  germ  to  spread  destruction,  thus  finally  pro- 
ducing what  we  call  "Consumption." 

If,  however,  the  body  is  put  under  favorable  conditions  of 
feeding,  of  fresh  air  and  of  wise  living,  its  cells  will  be  so 
strengthened  that  when  the  poison  of  the  germ 
The  Germ  attacks  them,  it  will  not  be  able  to  kill,  but  only 
Defeated —  to  irritate  them.  This  irritation  causes  them  to 
Fibrosis.  change  from  simple  round  cells  to  long  cells, 
which  gradually  turn  into  scar  tissue.  Undei 
favorable  conditions  this  wall  of  scar  tissue  slowly  gets  thicker 
and  thicker,  and  while  this  barrier  of  scar  is  being  built  around 
the  trouble,  Nature  is  busy  depositing  chalk  in  its  center.  If 
this  process  goes  forward  successfully,  in  the  course  of  two  or 
three  years  there  is  built  up  around  the  disease  a  strong  wall  of 
scar  tissue.  This  process  of  scar  tissue  formation  shutting  in 
the  trouble  is  what  we  call  "Fibrosis,"  and  it  is  by  such  Fibrosis 
that  the  body  manages  to  overcome  the  germ  and  to  free  itself 
from  active  evidences  of  disease.  Hence  the  disease  is  really 
a  struggle  between  "Caseation"  and  "Fibrosis,"  and  it  is  only  by 
doing  everything  we  can  to  favor  a  satisfactory  Fibrosis  that 
we  can  conquer  the  trouble.  From  this  it  is  evident  that  our 
efforts  at  treatment  must  be  chiefly  directed  to  strengthening  the 
patient's  body,  for  whatever  strengthens  this,  strengthens  the 
cells  which  compose  it  and  enables  them  to  build  up  a  strong 
wall  around  the  disease.  The  disease  can  be  compared  to  a 
battle  between  the  germs  which  have  gotten  into  the  body  and 
the  cells  which  make  it  up.  If  these  cells  are  well  nourished 
and  cared  for  they  will  win,  and  will  shut  in  and  finally  kill 
the  germ ;  if  not,  the  germs  will  by  degrees  kill  them  and  cause 
the  patient's  death. 

Once  the  disease  has  attacked  the  body,  it  always  leaves 

scars  behind,  as  a  careful  examination  of  dead  bodies  will  show. 

P      *vrt       -f     Since,  however,  with  careful  living,  these  scars 

°rv[rg *  y  °      wiH    remain    firm    and    strong,    enclosing    the 

trouble,  in  which  by  degrees  the  germ  may  die 

out,  patients  may  justifiably  be  considered  "cured" ;  but  it  must 

never  be  forgotten  that  as  a  result  of  dissipation,  overwork  or 


sickness,  the  disease  may  break  out  again.  The  examination  of 
the  lungs  of  those  who  have  been  healthy,  and  have  died  of  some 
other  cause,  will  show  that  a  very  much  larger  number  of  people 
have  had  active  trouble  at  some  time  in  their  lives  than  ever 
die  of  it,  the  scars  of  old  healed  disease  being  found  in  such 
cases. 

Tuberculosis  is  not  like  typhoid  fever,  or  smallpox,  or  mea- 
sles, or  scarlet  fever,  which  diseases  are  easily  and  quickly 
taken  if  you  come  in  contact  with  those  who  have  them,  and 
which  develop  in  from  one  to  two  weeks.  It  is  caught  much 
less  easily,  takes  a  long  time  to  develop  after  it  is  caught,  and 
can  be  prevented  from  developing,  very  often,  by  wise  life,  or 
can  be  cured,  or  arrested  in  a  large  number  of  cases  if  it  has  not 
gone  too  far.  Therefore,  it  is  not  necessary  to  despair  and  give 
up  hope  if  you,  or  some  one  you  love,  have  caught  this  disease, 
but  it  does  demand  an  immediate  improvement  of  your  ways  of 
life,  and  of  your  surroundings,  so  as  to  strengthen  your  body 
to  the  utmost  in  order  that  it  may  be  able  to  shut  in,  wall  up  and 
conquer  the  trouble.  The  cure  is  not  as  complete  as  it  is  in 
pneumonia,  for  instance,  where  after  the  disease  is  cured  there  is 
no  trace  of  it  left  in  the  body.  In  tuberculosis  scars  are  always 
left  and  germs  for  a  long  time  can  be  found  in  these  scars,  and 
unwise  living  can  enable  them  to  break  out  again,  but,  as  ample 
experience  has  shown,  it  can  be  so  successfully  walled  in  that 
all  symptoms  of  its  presence  may  be  lost,  and  the  patient  can 
resume  a  normal  and  useful  life  if  only  he  is  willing  to  live 
wisely  and  prudently.  However,  a  relapse  is  always  possible 
after  an  arrest,  even  after  many  years. 

V.  HOW  AND  WHEN  DO  PEOPLE  TAKE  THIS 
DISEASE? 

"The  conviction  has  gradually  been  strengthened  that  the 
first  infections  from  tuberculosis  often  occur  during  infancy 

and  childhood,  and  that  extreme  care  is  required 

Childhood  in-     if   this   is   to  be   avoided   in   tuberculous   fami- 

fection.  lies."     .     .     .     "It  is  now  generally  believed  that 

the  first  seat  of  disease  is  in  the  lymphatic 
glands,  where  the  bacilli  may  lie  quiet  for  many  years.  If  the 
number  and  virulence  of  the  bacilli  are  sufficiently  great,  disease 
may  follow  infection  in  a  short  time;  otherwise,  complete  heal- 
ing may  occur  without  the  development  of  any  recognizable 


symptoms  of  disease.  It  seems  probable  that  many  of  those 
who  develop  the  disease  in  adult  life  have  carried  the  latent 
infection  since  childhood  and  have  not  received  a  new  infection 
when  symptoms  of  the  disease  appear. 

.  "It  has  also  been  found  by  experiment  that  it  is  difficult  to 
reinfect  an  animal  that  has  already  been  inoculated  with  tuber- 
_  culosis.  Hence,  it  is  inferred  that  some  degree 

conger      o         Qf  immum'ty  must  be  thus  produced  that  may 
j-  serve  to  ward  off  bacilli  which  might  find  lodg- 

ment in  an  individual  not  previously  infected. 
Therefore,  it  will  be  understood  how  mild  infections,  which  are 
healed,  and  are  present  in  most  persons  who  have  reached  adult 
age,  may,  and  presumably  do,  offer  some  protection  against 
further  limited  invasions  of  the  tubercle  bacilli.  While  persons 
are  in  good  health,  the  protection  thus  offered  is  an  advantage, 
having  some  resemblance  to  vaccination,  but  only  very  limited 
in  nature  and  not  complete.  Prolonged  or  intimate  exposure, 
however,  or  exposure  to  a  severe  type  of  tuberculosis,  may 
result  in  a  new  infection,  even  of  those  who  have  overcome  a 
previous  mild  infection.  It  is,  moreover,  by  no  means  certain 
that  in  debilitated  conditions  due  to  other  diseases,  to  dissipa- 
tion or  to  bad  environment,  new  infections  may  not  occur.  We 
know  positively  that  the  first  childhood  infection  may  under 
such  circumstances  break  out  anew  and  thus  become  a  doubtful 
advantage,  a  real  sword  with  two  edges. 

"Considering  the  natural  and  acquired  resistance  to  infection 

which  is  unquestionably  possessed  by  adults,  much  unreasonable 

fear,    or   'phthisiphobia/   has   prevailed   in   late 

Unreasonable    years     The  resultg  of  this  have  sometimes  been 

"  b^ul     *U~     a  deplorable  neglect  or  persecution  of  consump- 
tives.    Because  there  is  no  precaution  too  great 
for  the  protection  of  the  young  and  delicate,  this  does  not  jus- 
tify healthy  adults  in  exaggerated  fears  for  their  own  safety."* 
As  has  been  said,  this  disease  is  probably  caught  in  most 
cases  in  childhood  and  lies  inactive  in  the  body  for  a  longer  or 
.   Q  shorter  time  until  the  conditions  are  favorable 
Tuberculosis      for  {t  tQ  develop    but  it  can  be  acquired  at  any 

*J.       °  u          time  or  age.    Since  the  germ  can,  and  often  does, 

lie  quiet  in  the  body  for  many  years  before  it 

develops  and  is  discovered,  it  is  usually  difficult  or  impossible  to 

say  just  when  or  under  what  circumstances  the  person  became 

*  Dr.  Hermann  M.  Biggs,  Journal  of  the  Outdoor  Life,  March,  1914.  '      -1 


!  8 

infected.  It  should  always  be  remembered  that  it  is  almost 
always  a  house  or  indoor  infection,  and  that  it  is  rarely  or  never 
caught  outdoors  where  the  sunlight,  which  is  our  best  disinfec- 
tant, quickly  kills  the  germ.  Thus  the  great  and  real  danger  is 
from  living  with  careless,  dirty  consumptives,  and  especially,  in 
dark,  damp,  dirty  or  ill-ventilated  houses,  sleeping  and  living 
rooms,  workshops,  factories  or  stores,  which  have  become 
infected  with  the  germ  by  the  sick  people's  careless  spitting 
habits.  The  germ,  which  is  a  microscopic  rod,  invisible  to  the 
unaided  human  eye,  is  found  in  millions  in  their  spit  from  very 
early  in  the  disease,  and  it  is  through  this  spit  almost  alone  that 
it  reaches  others.  If  we  could  collect  and  destroy  all  the  spit  of 
such  patients  and  make  them  cover  their  mouths  when  they 
cough,  we  could  almost  wipe  out  the  disease.  Fortunately,  when 
people  spit  outdoors  the  danger  is  not  quite  so  great,  since, 
sooner  or  later,  the  sunlight  will  destroy  the  germ;  but  when 
they  spit  indoors,  as  many  do,  where  the  sun  cannot  get  at  the 
germ  and  kill  it,  it  may  remain  alive  and  active  for  a  long  time. 
Hence  people  who  spit  in  this  way  are  a  terrible  danger  to  all 
who  live  with  them,  or  to  those  who  stay  in  the  places  where 
they  live  or  work.  Many  people  do  not  know  that  they  have 
tuberculosis,  but  think  that  they  have  only  a  "bad  cough,"  when 
they  already  have  the  disease  and  are  bringing  up  the  germs  in 
their  spit.  Every  one,  therefore,  who  spits  or  has  a  cough  should 
be  just  as  careful  about  his  spitting  as  if  he  knew  that  he  had 
tuberculosis.  If  those  with  germs  in  their  sputum  spit  on  floors 
or  sidewalks,  the  sputum  will  be  ground  under  foot,  blown 
around  as  dust  in  the  air,  and  inhaled  by  other  people,  and  will 
finally  reach  their  lungs.  Even  when  they  use  spittoons,  unless 
the  water  be  carbolized,  flies  will  get  at  the  sputum  and  carry  it 
on  their  feet  to  other  people's  food,  and  thus  possibly  infect 
them. 

In  the  home  the  chief  danger,  as  has  been  said,  is  to  children, 
although    adults    may   also   become   infected.      The   two   chief 
sources  of  infection  for  children  are,  first,  con- 
Infection     sumptive   relatives   or   fellow  lodgers,  and   sec- 
from    care-     ondly,    infected    rooms,    dwellings    or    dishes. 
less    per-     Children  are  apt  to  be  kissed  and  fondled,  and 
sons  in  the     in  this  way  the  germs  may  be  carried  directly 
home.  to  them.    Again,  they  play  around  on  the  floors, 

too  often  infected  with  spit,  arid  thus  acquire 
the  trouble.  Therefore,  the  kissing  or  fondling  of  little  chil- 
dren by  sick  relatives  or  friends  should  be  prohibited,  as 


well  as  the  bad  habit  of  feeding  them  from  the  spoons  and 
plates  of  such  people.  Indeed,  as  far  as  possible,  children  should 
be  kept  away  from  their  sick  relatives  as  long  as  the  latter 
cough  and  spit. 

No  one  should  move  into  a  new  lodging  without  finding  out 
first  something  about  the  last  lodgers,  and  making  a  careful 
disinfection  of  the  rooms,  if  the  previous  resi- 
T  h  e    danger     dents  were  sick  or  coughed  badly.     In  the  dark 
of  infected     corridors  of  many  houses  the  germ  may  live  for 
rooms.  a  long  time  and  unfortunately  many  people  who 

would  not  spit  on  the  floor  of  a  bedroom,  will  do 
so  on  the  floor  of  a  corridor.  If  every  one  who  reads  this  will 
see  to  it  that  his  home  is  kept  strictly  clean,  that  as  much  sun- 
light as  possible  is  admitted  to  it,  and  that  no  one  is  allowed  to 
spit  there  carelessly,  it  will  do  much  to  lessen  his  family's  danger 
of  catching  this  disease. 

The  dry  sweeping  of  rooms  should  never  be  allowed,  as  it 

raises  clouds  of  dust,  which  may  contain  the  germs,  which  are 

thus  breathed  directly  into  the  lungs.    Therefore, 

Dangers     o  f     a^  broom  sweeping  should  be  preceded  by  strew- 

s  w  e  e  ping     ing  the  floor  with  damp  sawdust,  old  tea  leaves 

and    dust-     or  bits  of  wet  paper  or  something  similar,  and  if 

ing.  it  is  at  all  possible,  vacuum  sweeping  or  cleaning 

should  be  used. 

Outside  of  the  home,  there  is  much  danger  in  shops,  work- 
shops, factories  and  mills.     Experience  shows  that  both  clerks 
and  workmen  too  often  spit  promiscuously  on 
How    work-     ^e  fl°ors  °f  their  work  places,  and  since  many 
ing  men  in-     °f  them,  often  without  knowing  it,  have  the  dis~ 
f  e  c  t     one     ease,  they  infect  their  fellow  workmen,  and  every 
another.          year  thousands  of  American  laborers  are  made 
sick  in  this  way.    If  only  our  labor  unions  knew 
the  great  danger  to  their  members  from  the  careless  spitting 
habits  of  sick  workmen,  they  would  insist  that  every  one  who 
spits  should  use  a  spittoon  containing  water  with  a  tablespoonful 
of  carbolic  acid  to  the  pint,  and  they  would  see1  to  it  that  those 
who  persist  in  breaking  this  rule  should  be  dismissed  from  the 
union.    In  this  way  they  could  greatly  lessen  the  number  of  their 
members  who  get  this  disease. 


10 

Infection  also  comes  about  from  a  patient  spraying  out  and 

Infection  scatter*n£  around  nne  drops  of  moist  spit  when 

f  r  o  m    a  he   coughs   or  sneezes.     This  could   be   entirely 

cough  ing  avoided  if  every  one  formed  a  habit  of  covering 

patient,  his   mouth  with  a  handkerchief  at  such  times. 

"Dr  o  p  1  e  t  This  danger  is  so  real  that  public  opinion  should 

Infection."  enforce  such  a  custom. 

The  germ  may  also  be  taken  into  the  body  in  uncooked 
cow's  milk.     Cows  frequently  have  tuberculosis  and  the  germ 
may  get  into  the  milk,  sometimes  in  large  num- 
Infection     bers.    While  in  grown  people  this  is  not  a  com- 
through     mon  source  of  infection,  it  is  a  common  source 
Milk.  in   little    children    who    drink    much    uncooked 

cow's  milk.  The  germs  are  carried  by  the  milk 
into  the  bowels  through  whose  walls  they  pass  and  enter  the 
system  through  the  lymphatics,  lodging  usually  in  the  glands 
around  the  roots  of  the  lung,  or  in  those  attached  to  the  intes- 
tines. Therefore,  unless  one  is  certain  that  the  cow  which  sup- 
plies the  milk  is  free  from  tuberculosis  (which  can  be  told  by 
a  test  that  a  good  veterinary  doctor  can  easily  make),  the  only 
safe  thing  is  to  pasteurize  or  boil  all  milk  which  is  used  by  the 
children  of  the  household. 

There  are  a. number  of  other  sources  of  infection,  but  they 

are  not  very  important  and  we  need  only  mention  a  few,  such 

as  the  kissing  of  consumptives ;  the  regular  use 

Other  sources     of  their  unwashed  dishes  or  clothing,  and  careless 

o  f     infec-     contact  with  the  pus  or  other  discharges  from 

tion.  tuberculous  sores.    It  has  been  shown  that  there 

can  be  a  danger  of  infection  from  the  unwashed 

hands  of  consumptives,  and  all  such  patients  should  wash  their 

hands,  faces  and  mouths  frequently. 

It  is  now  known  that  tuberculosis  is  not  hereditary,  and  that 
it  is  practically  never  handed  on  from  the  parents  to  the  child 
before  birth.    We  recognize,  on  the  contrary,  that 
Hereditary     the  infection  comes  from  tuberculous  parents  or 
Infection.        relatives,  who  usually  infect  the  healthily  born 
child  a  short  time  after  birth,  if  their  habits  are 
careless.     Even  with  much  care  it  is  difficult  to  avoid  the  infec- 
tion of  the  children  by  their  tuberculous  parents.    When  we  see 
a  whole  family  die  of  this  disease,  one  after  another,  it  does  not 
mean  that  they  inherited  it  from  the  parents,  but  that  there  was 


11 

carelessness  in  the  family  and  that  each  child  in  turn  acquired 
the  disease  from  the  careless  parent,  brother  or  sister.  How- 
ever, in  families  in  which  there  has  been  much  tuberculosis 
among  the  parents  or  grandparents,  there  is  at  times  found  a 
lowered  resistance  to  the  disease  so  that  the  children  in  such 
families  must  be  brought  up  with  especial  care  as  to  their  sur- 
roundings and  life. 

As  has  already  been  shown,  when  this  disease  is  acquired,  it 
does  not  usually  develop  at  once,  but  may  lie  latent  in  the  body 
anywhere  from  one  to  twenty  or   more  years. 
Latent     T  u  -     During  this  time  it  may  sometimes  cause  some 
berculosis.      symptoms  which  only  a  doctor  would  recognize, 
and  which  pass  off  so  soon  that  the  patient  pays 
no  attention  to  them.    Thus  people  who  are  subject  to  repeated 
spells  of  "grippe"  or  colds  every  winter,  or  to  attacks  of  pleurisy 
now  and  again,  those  who  suffer  from  periods  of  "rundown- 
ness,"  or  who  are  obstinately  dyspeptic  and  habitually  pale  and 
below  normal  weight,  or  are  chronic  coughers  and  spitters,  are 
very  apt  to  be  really  tuberculous,  and  often,  unconsciously,  hand 
on  the  disease  by  their  cough  to  others.  v 

From  what  has  been  said,  it  is  plain  that,  if  all  people  who 

have  any  spit  would  destroy  it  carefully,  would  cover  their 

mouths  when  they  cough,  would  refrain  from 

The  duty  of     kissing  and  would  keep  their  hands  clean,  and  if 

the  patient     all  milk,  for  children  at  least,  were  boiled  before 

to  the  com-    use,  unless  it  came  from  veterinarily  tested  cows, 

munity.  it  would  not  be  long  before  we  would  get  rid  of 

the  trouble  entirely. 

'   VI.  HOW  CAN  YOU  AND  YOUR  FAMILY  KEEP  FROM 
GETTING  THE  DISEASE? 

See  that  you  and  your  children  do  not  move  into  any  room, 
house  or  workplace  where  a  consumptive  or  a  person  with  a 
chronic  cough  has  lived,  worked  or  died,  until  it 
Thorough     ^as  keen  carefully  disinfected  by  the  Board  of 
disinfection     health  or  your  doctor.     Any  room  or  house  can 
of  homes.       be    made    perfectly    safe    without    very    much 
trouble.      First,    by    formaldehyd    disinfection. 
Hang  up  by  two  corners  in  each  room  a  sheet 
thoroughly  wet  with  a  quart  of  40  per  cent,  formaldehyd  solu- 
tion, which  can  be  gotten  cheaply  at  any  drug  store,  after  first 


12 

i. 
shutting  all  the  doors,  windows  and  fireplaces,  and  stopping 

up  all  the  cracks  with  strips  of  newspaper  put  on  with  starch 
paste.  Keep  the  room  shut  for  twenty-four  hours,  and  then  keep 
all  windows  wide  open  'for  two  days.  There  are  several  better 
but  more  expensive  methods  of  disinfection  with  formaldehyd, 
which  you  can  learn  of  from  the  Board  of  Health  or  your  doctor. 

Second,  and  far  more  important,  by  thorough  scrubbing  with 
hot  carbolized  soap  suds  and  water,  followed  by  exposure  to 
fresh  air  and  sunlight.  Remember,  that  mere  fumigation  with 
formaldehyd,  without  vigorous  application  of  soap  and  water, 
and  the  letting  in  of  sunlight  and  air,  will  not  kill  the  germs  of 
tuberculosis.  Therefore,  after  the  formaldehyd  disinfection,  wipe 
down  all  the  walls  and  ceilings  carefully  with  cloths  dampened 
with  some  disinfectant  solution ;  then  scrub  thoroughly  with  hot 
water  (in  which  put  two  tablespoonfuls  of  carbolic  acid  or  of 
chlorid  of  lime  to  every  quart)  all  the  floors  and  woodwork. 
Then  open  the  windows  to  admit  sunlight  and  air  for  two  days. 
After  such  a  procedure  you  need  have  no  fear  of  infection  in  that 
room. 

See  that  no  one  in  your  house  or  in  the  place  where  you  work, 

whether  he  thinks  himself  well  or  not,  is  ever 

Stop   promis-     anowe(j  to  spjt  on  the  floor,  or  anywhere  where 

fj  ^S  his  spit  cannot  be  burned  up  or  thrown  down 

the  sewer. 

See  that  your  home  or  workplace  has  windows  that  open  out- 
doors in  each  room,  and  never  take  a  room  whose  windows  open 

on  a  narrow  airshaft,  or  which  is  windowless. 

T  .  ,  .  .  These  windows  should  be  opened  often  and  far 
Light,  air  . ,  e  r  t 

and    clean-     enougn  to  provide  a  good  supply  of  fresh  air, 
liness.  an(^  your  rooms  and  corridors  should  be  kept  as 

clean  as  scrubbing  brush,  hot  water  and  sun- 
light can  make  them. 

Keep  the  bodies  of  yourself  and  your  family  strong,  healthy 

and  resistant  by  good,  properly  cooked,  even  if  very  simple  food ; 

by  taking  at  least  one  warm  bath  a  week;  by 

Care    of    the     the  avoidance  of  late  hours,  dissipation,  drink 

body.  and  unduly  long  hours  of  work,  and  by  spending 

all  your  rest  hours  as  far  as  possible  outdoors  and 

in  healthful  amusements. 


13 

Never  cramp  your  lungs  by  tight  or  too  heavy  clothing,  or. 
by  stooped  shoulders,  or  by  stopped-up  noses  or  throats,  which 
prevent  proper  air  getting  to  your  lungs.    If  you 
Clothing  and     or   your   children  have   stooped,   hollow,  badly 
exercise.          developed  chests,  practice  regular  deep  breath- 
ing,  keeping  the   shoulders  back,  and  do   easy 
gymnastics  to  broaden  the  chest.    If  your  nose  seems  stopped  up, 
go  to  a  nose  and  throat  doctor,  or  to  a  dispensary,  and  have  it 
opened  by  proper  treatment. 

Keep  your  children  out  of  sick  rooms,  especially  those  of 
Keep  your  people  who  have  coughs,  because  children,  as  has 
c  h  i  1  d  r  en  been  said,  get  this  disease  easily.  While  you 
away  from  need  never  be  afraid  of  the  careful  cleanly  tuber- 
c  o  n  sump-  culous  patient,  avoid  unnecessary  contact  with 
tives.  careless  consumptives,  as  it  may  be  dangerous. 

VII.  IF  YOU  CATCH  THE  DISEASE,  HOW  CAN 
YOU  FIND  IT  OUT  SOON  ENOUGH  TO  CURE  IT? 

Remember  that  this  disease  can  be  cured  in  the  majority  of 
cases  if  it  is  discovered  early,  while  if  it  is  not  found  out  until 

it  is  advanced,  it  is  hard  to  cure  it  at  all. 

Early  discov-       In  early  cases,  proper  food,  rest  in  the  open 

e  r  y     the     air  by   day,   and,   if   possible,   by   night ;   clean 

great  es-     surroundings,  and  if  at  all  possible,  the  help  of 

sential.  an  intelligent  doctor  will  do  wonders.     Since  if 

tuberculosis  is  to  be  cured,  it  must  be  found  out 

early,  it  is  very  important  to  understand  the  early  symptoms 

which  warn  us  of  its  presence. 

Unfortunately,  many  doctors  do  not  give  especial  attention 
to  this  disease  and  overlook  it  until  too  late,  or  mistake  it  for 
other  things,  especially  "grippe,"  "a  chronic  cold,"  malaria, 
stomach  trouble  and  nervous  prostration.  A  careful  doctor  will 
always  strip  your  chest  to  the  skin  for  examination,  and  no 
examination  through  the  clothes  is  of  any  use  at  all.  Further, 
he  will  study  your  fever  every  two  hours  for  at  least  a  week, 
will  have  your  sputum  examined  in  every  case  and  will  go  very 
carefully  into  the  past  history  of  your  case  and  your  surround- 
ings. ^If  these  things  are  not  done  it  will  be  impossible  to  find 
out  the  trouble  in  any  but  advanced  hopeless  cases.  If  you  can- 
not get  a  doctor  to  examine  you  in  this  thorough  way,  go  at  once 
to  the  nearest  dispensary  and  have  your  case  studied  carefully 
by  some  one  familiar  with  this  trouble. 


14 

If  you  cannot  get  expert  advice,  an  intelligent  study  of  your 
symptoms  may  make  you  reasonably  sure  of  what  you  have. 

The  disease  may  begin  in  different  ways.  The 

Early    symp-     most  common  early  symptom  is  possibly  a  slight 

toms.  cough,  usually,  but  not  always,  in  the  morning, 

and  which  will  not  yield  to  treatment.     Every 

cough  that  lasts  more  than  three  weeks  should  be  regarded  as 

suspicious.    A  chronic  cough  with  spitting  which  has  lasted  for 

years,  even  though  it  has  never  made  its  owner  sick,  is  very 

suspicious. 

Often,  however,  before  a  cougfh  appears  there  are  other 
symptoms  which  warn  us,  and  of  these  none  is  more  useful  than 
an  unwonted  sense  of  tiredness,  exhaustion  or  weariness,  com- 
ing on  without  any  good  reason.  This  is  often  supposed  to  be 
only  laziness,  or  is  ascribed  to  "malaria,"  "nervous  prostration," 
or  to  other  conditions.  It  usually  comes  on  in  the  afternoon 
between  2  and  6  o'clock,  and  may  be  accompanied  by  flushed 
cheeks,  bright  eyes  and  feverishness.  Often  the  patient  will 
waken  just  as  tired  as  he  went  to  sleep.  Just  as  with  the  cough, 
so  persistent  weariness  should  cause  you  to  consult  your  doctor. 

Again,  a  long-continued  hoarseness  which  does  not  leave  is 
suspicious.  An  important  symptom  of  the  trouble  is  a  steady 
and  unexplained  loss  of  weight,  and  this  should  always  excite 
one's  thought.  A  very  suggestive  early  sign  is  loss  of  appetite 
or  persistent  indigestion  or  "stomach  trouble."  The  indigestion 
may  have  lasted  for  years  and  have  had  all  sorts  of  treatment, 
and  when  a  cough  appears,  it  is  spoken  of  as  a  "stomach  cough"  ; 
but  the  only  safe  way  is  to  have  a  careful  physician  investigate 
why  you  are  having  indigestion  and  why  you  cough.  Fre- 
quently the  trouble  begins  with  a  slight  blood-spitting,  which 
may  not  be  followed  for  a  long  time  by  the  development  of  real 
trouble,  and  where  the  doctor  can  find  no  changes  in  the  lungs, 
but  such  blood-spitting,  or  blood-streaked  sputum,  is  practically 
always  a  sign  of  tuberculosis  and  must  never  be  neglected 
or  explained  away  without  a  long  and  careful  study  of  the  case. 
Night  sweats  will  at  times  be  the  first  symptom,  but  they  are 
usually  preceded  for  a  long  time  by  other  symptoms :  and  are 
not  a  common  early  symptom.  A  persistent  pain  in  the  chest, 
especially  in  the  shoulder,  should  be  carefully  investigated,  and 
not  passed  off  as  "rheumatism"  or  "neuralgia,"  as  at  times  it  is 
the  first  manifestation  of  a  tuberculous  pleurisy  of  the  top  of 
the  lung. 


15 

Fever  is  not  usually  an  early  symptom,  unless  we  use  a 
thermometer  to  find  it,  but  at  times  the  patients  will  notice  that 
they  are  hot  and  flushed  in  the  afternoon,  and  the  thermometer 
will  show  that  while  the  temperature  is  normal,  or  below  nor- 
mal in  the  morning,  in  the  afternoon  it  rises  from  a  degree  to 
a  degree  and  a  half.  Usually  after  the  cough  has  lasted  a  little 
while,  some  spitting  is  apt  to  begin,  and  this  must  never  fail  to 
be  carefully  examined  often  under  the  microscope  by  the  local 
Board  of  Health,  or  by  your  doctor.  If  the  germs  are  found, 
it  is  certain  that  you  have  the  trouble,  but  even  if  they  are  not 
found,  it  should  never  be  forgotten  that  this  does  not  prove  the 
disease  is  not  present,  for  the  germs  are  often  absent  from  the 
sputum  for  a  long  time. 

Any  or  all  of  these  symptoms  are  suspicious  and  should 
cause  you  to  consult  a  careful  doctor.     If  you  cannot  get  to  a 
doctor   you   are   pretty    safe   in   taking   it    for 
Don't    wait     granted  that  when  a  person  has  a  persistent, 
until    it    is     slight  cough,  with  loss  of  weight,  appetite  and 
too  late.          strength,  with  probably  some  tiredness  and  pos- 
sibly some  slight  sweating,  he  has  the  begin- 
nings of  this  disease.     Remember  also  that  fever,  chills  and 
sweats  are  just  as  often  caused  by  tuberculosis  as  by  a  malaria, 
sometimes  known  as  "chills  and  fever." 

Even  if  the  doctor  cannot  find  the  signs  of  tuberculosis  when 
some  of  these  symptoms  appear,  and  it  is  very  often  impossible 
to  do  so  at  this  time,  it  is  much  safer  and  wiser  not  to  wait  until 
he  can  find  them  before  taking  precautions.  In  some  cases  this 
may  be  a  matter  of  months  and  may  make  it  too  late  to  do  any 
good.  Therefore,  in  the  face  of  such  symptoms,  whatever  the 
doctor  finds,  alter  your  methods  of  living  at  once,  increase  your 
fresh  air,  improve  your  food,  lengthen  your  hours  of  sleep  and 
rest,  and,  if  at  all  possible,  lessen  your  hours  of  work.  Thus 
you  may  strengthen  your  body  to  the  point  where  it  can  throw 
off  the  beginning  disease.  He  who  insists  on  being  absolutely 
sure  that  he  has  the  disease  before  he  begins  to  treat  it,  will 
often  throw  away  his  best  chance  for  getting  well,  for  when 
there  are  such  unmistakable  symptoms  as  hollow  cough,  abun- 
dant spitting,  high  fever,  profuse  sweats,  flushed  cheeks  and 
great  loss  of  weight,  it  is  usually  very  much  harder,  if  not  impos- 
sible, to  get  a  cure. 


16 

VIII.  IF  YOU  HAVE  CONTRACTED  THE  DISEASE, 
CAN  YOU  GET  WELL,  AND  HOW? 

In  any  given  case  a  sensible  doctor  can  usually  tell  you 
whether  there  is  a  chance  of  your  getting  well.  As  has  been 
said,  early  light  cases  are  curable  in  the  majority  of  instances. 
More  advanced  disease,  with  careful  treatment,  yields  a  good 
percentage  of  recoveries,  and  it  is  worth  remembering  that  a 
certain  number  of  very  bad  and  apparently  hopeless  cases  do,  at 
times,  recover  when  it  seemed  impossible  for  them  to  do  so. 
Therefore,  however  bad  the  outlook,  it  is  sensible  not  to  give  up 
hope,  but  to  start  right  in  to  make  the  bravest  fight  you  can. 

In  any  case  your  chance  of  getting  well  depends  largely  on 

the  early  discovery  of  the  trouble  and  on  your  grit  and  courage. 

_  A   brave    and    determined   patient   with    a   bad 

Recovery  de-     troubje  generally  stands  a  better  chance  of  recov- 

ery  than  a  s^y»  weak-willed  one  with  much  less 


YOU 

trouble. 

Tuberculosis  of  the  lungs  may  appear  in  many  forms,  most 
of  them  tending  to  be  chronic,  slow  and  long  drawn  out;  of 

these   a   large  number  are  curable  ;   a   few   are 

Your    chance     acute,   rapid,   galloping,   and  these  are  usually 

of  a  cure.        hopeless  from  the   start,  while  there  are  some 

intermediate  cases  which  look  very  bad  in  the 
beginning,  but  which,  with  great  pains  and  care,  may  finally  be 
cured.  Of  the  light  and  medium  cases,  discovered  early,  and 
which  can  get  good  conditions  of  life  and  sanatorium  treat- 
ment, the  majority  can  be  cured  so  as  to  allow  of  a  return  to 
suitable  work  and  self-support,  provided  there  is  a  proper  care 
of  the  future  life  and  avoidance  of  harmful  influences.  Even 
in  more  severe  and  advanced  cases  with  much  trouble  in  the 
lungs,  by  a  course  in  a  good  sanatorium,  followed  by  careful 
life  at  home,  a  fair  degree  of  health  may  often  be  regained,  so 
that  one  need  never  lose  hope. 

The  length  of  time  it  will  take  to  be  restored  to  working 

efficiency  varies  according  to  the  severity  of  the  case;  from  six 

months  in  the  most  favorable  cases  to  two  or 

How  long     three   years,   or   more,   in   obstinate   ones.     We 

will      it     know  that  a  good  number  of  cases  can  be  and 

take?  are   cured;    and    since   some   very    severe   cases 

recover,  it  is  alv/ays  right  to  hope  and  strive  to 

get  well  even  if  you  seem  to  be  very  sick. 


17 

Getting  well  does  not  mean  the  taking  of  a  lot  of  medicine. 

There  is  no  medicine  which  by  itself  cures  tuberculosis  while  the 

..,    patient  keeps   on  living   the   old  kind   of  life. 

Avoidance  of     Nothing   has  done  more  harm  in  this  disease 

drugs.  than  the  habit  of  taking  patent  medicines,  which 

I     make  lying  claims  to  cure  the  trouble,  when  in 

fact  they  only  stop  the  cough  and  pain  by  the  opiates  in  them, 

which  makes  death  easier  but  not  any  less  sure  or  quick.    Hence, 

any  medicine  which  claims  to  cure  tuberculosis  is,  on  the  face 

of  it,  a  fake  and  its  makef  a  liar.    Avoid  all  such  if  you  value 

your  life.     Some  medicines  which  your  doctor  can  give  you  are 

a  help,  but  you  are  safer  with  no  medicine  at  all,  unless  one 

recommended  by  your  physician. 

When  an  intelligent  doctor  has  found  out  your  trouble, 
make  every  effort  to  get  into  a  well-conducted  sanatorium  for 
tuberculosis ;  or,  if  this  is  impossible,  at  least  to 
Value  of  San-  attend  the  tuberculosis  dispensary  in  your  town 
a  t  o  r  i  u  m  regularly  and  join  the  tuberculosis  class,  if  there 
treatment.  is  one.  If  you  cannot  afford  to  go  to  a  special 
climate  and  get  there  comfortable  and  proper 
conditions,  go  to  the  state,  city  or  county  tuberculosis  hos- 
pital. The  cost  of  treatment  in  private  sanatoriums  ranges 
from  $15  to  $30  a  week.  To  get  proper  conditions  at 
a  health  resort  will  demand  $65  to  $100  a  month.  There 
are  a  few  semi-charitable  sanatoria  where  'the  rates  are  from 
$7  to  $12  a  week.  In  city,  county  or  state  hospitals  the 
rate  is  usually  from  $4  to  $7  a  week,  but,  in  almost  all, 
patients  who  cannot  afford  this  are  cared  for  free  at  public 
expense.  At  the  sanatorium  you  will  not  only  get  the 
advantage  of  better  climatic  conditions,  or  at  least  of  country 
air,  but,  what  is  far  more  important,  constant  medical  super- 
vision and  the  careful  teaching  and  training  of  physicians  and 
nurses  in  how  to  conduct  your  life  and  how  to  care  for  your 
case  in  the  future.  A  complete  cure  will  usually  not  be  accom- 
plished at  the  sanatorium,  for  you  would  have  to  stay  there  too 
long  a  time  for  that.  The  activity  of  the  trouble,  however,  will 
be  stopped,  you  will  lose  most  of  your  symptoms  and  will  prob- 
ably feel  perfectly  well.  This  is  a  dangerous  time,  for  you  are 
not  really  well  and  you  may  be  tempted  to  be  imprudent,  but 
if  you  have  been  a  good  pupil  and  have  learned  how  to  live,  you 
will  avoid  this  danger,  and  will  know  how  you  must  live  when 
you  go  home.  'By  all  means  stay  at  the  sanatorium  as  long  as 


18 

the  physician  there  advises,  or  as  long,  at  least,  as  your  means 
will  permit. 

When  you  are  discharged  as  an  arrested  case,  you  will  usually 

go  home  able  cautiously  to  resume  your  work,  and,  by  carrying 

out  instructions  you  will  generally  be  restored 

Life     when     to  good  health  in  two  or  three  years.    You  must 

you       go     remember,     however,     that    unlike    pneumonia, 

home.  measles  and  other  acute  infectious  diseases,  after 

tuberculosis  you  can  relapse  and  get  sick  again 

at  any  time,  when  dissipation,  overwork,  unhealthy  conditions 

of  life,  or  too  little  food,  or  certain  sicknesses  like  grippe  or 

typhoid,  lower  your  vitality  below  the  danger  point  and  enable 

the  disease  to  get  a  new  hold  on  you.     Therefore  your  staying 

well  will  depend  upon  eternal  vigilance  and  common  sense. 

If  there  is  no  dispensary  or  sanatorium  available  for  you 
and  you  cannot  possibly  get  proper  conditions  and  good  medical 
treatment   away    from   home,   don't   lose    heart. 
Home     treat-     While  change  of  climate  under  proper  conditions 
ment  when     is  valuable,  without  those  conditions  it  is  useless, 
a      sanato-     and  in  any  case  it  is  never  the  first  or  most 
rium  is  im-     important  thing,   and  it  is  possible  for  you  to 
possible.          win  out  with  sense  and  determination  by  tak- 
ing   the    treatment    at    home.      Go    to    a    good 
doctor,  not  so  much  to  get  medicines  as  to  have  him  teach 
you  how  to  live,  and  to  guide  your  life  and  watch  your  case 
carefully.     Keep  for  him  a  written  record  of  exactly  what  you 
do  every  day,  and  how  you  feel  both  physically  and  mentally, 
and  the  run  of  your  temperature  every  four  hours.    Let  him  see 
this  once  or  twice  a  week  and  advise  you  accordingly.     Apply 
the  teachings  of  this  booklet  to  your  daily  life  and  carefully 
follow  all  its   instructions,   especially   those  meant  to  prevent 
the  spread  of  the  disease  in  your  family. 

Get  a  bright  sunny  room  with  two  outside  windows  and  a 
southern  exposure  if  possible  and  the  use  of  a  roof  to  sit  out  on 

in  good  weather.  If  your  town  is  dusty,  try  to 
Your  room.  get  rooms  on  the  top  floor  of  a  high  building,  for 

here  you  will  escape  much  of  the  dust  which  is 
irritating  to  your  lungs  and  throat.  A  special  pamphlet  on 
"Directions  for  Living  and  Sleeping  in  the  Open  Air"  will  be  sent 
to  you  free,  on  request  to  the  National  Association  for  the  Study 
and  Prevention  of  Tuberculosis,  105  East  Twenty-Second  Street, 


19 

New  York.     This  will  show  you  how  to  fix  your  room,  porch, 

roof  or  tent  so  that  you  can  be  most  comfortable  in  the  open  air. 

Try  and  get  the  best  and  most  nourishing  food  possible,  as 

much  meat  as  you  can,  once  or  even  twice  a  day,  preferably 

broiled  or  roasted,  and  as  much  good  milk,  but- 
Food.  ter  and  eggs  as  you  can  afford.  While  milk  and 

eggs  are  valuable  if  you  can  digest  them  well, 
they  will  do  you  no  good  if  they  upset  your  stomach ;  other  foods 
can  take  their  place.  A  good  amount  of  green  vegetables  in  the 
diet  is  necessary. 

If  you  can  stop  your  work  for  six  months,  do  so  and  begin  a 
rest  cure  at  home  on  your  porch  or  in  your  back  yard,  or,  if  this 

is  not  possible,  in  your  room  with  every  window 

Rest  in  the        wide  open  and  yourself  well  wrapped  up  in  cold 

open  air.         weather.     Carry  out  the  cure  faithfully  by  con- 

v  .  stant  rest  in  the  fresh  air  in  a  reclining  position, 

until  your  fever,  for  a  month  at  least,  has  disappeared.    Then 

resume  exercise  with  the  greatest  care. 

Keep  your  body  clean  by  a  weekly,  or  better,  a  daily  bath, 
and  in  winter  wear  sufficient  warm  but  light  clothing ;  but  do  not 
bundle  up  so  warmly  as  to  make  you  sweat  or  tire  you.  Do  not 
muffle  your  throat  up  in  shawls,  nor  wear  chest  protectors.  Have 
your  room  kept  as  clean  as  possible  with  soap  and  water  and  a 
scrub  brush,  and  keep  all  blinds  and  window  shades  wide  open 
so  as  to  let  in  all  the  air  and  sunlight  you  can.  Remember,  it 
is  better  to  let  the  sun  fade  your  carpets  and  pictures  than  to  keep 
these  un faded  and  kill  yourself.  If  you  are  properly  wrapped 
up,  all  the  windows  can  be  open  day  and  night  in  winter  as  well 
as  in  summer.  Night  air  is  just  as  good  and  just  as  necessary  as 
day  air.  If  you  are  not  used  to  fresh  air,  go  about  it  gradually, 
opening  each  window  a  little  further  each  night  until  they  are 
all  as  wide  open  as  they  can  be,  half  down  from  the  top  and  half 
up  from  the  bottom.  Get,  if  you  can  possibly  afford  it,  an  easy 
reclining  chair  with  a  flat  back  and  with  some  means  of  keeping 
your  legs  up  off  the  ground,  and  except  when  it  rains  spend  your 
whole  day  out  of  doors,  but  spend  very  bitter  or  rainy  and  windy 
days  in  your  room  with  all  the  windows  open.  If  you  have  to 
sleep  in  a  room  instead  of  on  a  porch,  keep  all  the  windows  wide 
open,  have  plenty  of  warm  but  light  bed  clothes  and  keep  your 
bed  near  one  of  the  windows,  or  use  a  window  tent.'  Always 
dress  and  undress  in  a  warm  room. 


20 

The  control  of  your  exercise  is  one  of  the  most  important 

things  in  the  treatment.     At  first,  avoid  all  exercise,  for  many 

more  consumptives  are  killed  from  over-exercise 

Exercise.  than  are  ever  hurt  by  too  much  rest.    Keep  this 

up  until  you  can  notice  no  fever  over  99.5  in  the 

afternoon  and  until  you  are  gaining  weight.    When  you  begin  to 

exercise,  let  it  at  first  be  for  not  more  than  two  or  three  minutes, 

slowly  increasing  it  by  a  minute  or  so  each  day,  and  stopping 

at  once  if  it  brings  back  your  fever  or  if  it  makes  you  tired  or 

short  of  breath. 

Never  swallow  your  spit  under  any  circumstances,  because 
in  this  way  you  can  infect  your  bowels  and  might  get  a  hopeless 
and  terrible  form  of  this  disease.     If  you  are 
Further     hoarse,  or  if  your  throat  is  sore,  do  not  talk  at  all, 
hints.  or  as  little  as  possible.     Do  not  smoke  and  let 

nobody  smoke  in  your  room  under  any  circum- 
stances, and  avoid  all  smoky  and  dusty  places.  By  living  in  this 
way,  people  all  over  this  country  have  been  cured,  and  are  being 
cured  every  year  of  this  disease,  and  there  is  no  reason  why  you 
should  not  get  well.  Do  not  suppose,  however,  that  you  are 
well  as  soon  as  most  of  your  symptoms  stop ;  the  disease  is  still 
present  and  active  long  after  you  can  notice  no  signs  of  it,  and  if 
you  get  careless  or  forgetful  and  do  imprudent  things,  it  can 
come  back  on  you.  Therefore,  keep  up  a  modified  form  of  the 
cure  for  at  least  a  year  after  you  feel  well,  and  for  all  the  rest 
of  your  life  live  carefully,  remembering  what  you  have  escaped. 
If  you  fight  it  out  bravely  on  these  lines,  drive  away  the  blue 
devils  and  insist  on  being  careful,  you  will  be  surprised  to  find 
how  well  you  will  do  and  how  you  will  gain  weight,  strength 
and  appetite  and  lose  your  symptoms. 

After  most  acute  diseases  are  over,  the  patient  is  as  well  as 
ever,  barring  complications,  and  is  often  somewhat  more  resis- 
tant to  a  new  attack  of  the  same  malady  than  a 

Ttitt-.*     .*  u*      man  wno  nas  never  had  the  disease.    Tuberculo- 
Diiierence  DC-  ,  .  ,        .     j.  «  i 

tween  "Ar-     S1S)  nowever>  1S  a  chronic  disease  and  has  no 
rest"      and     nm^ed  period  of  duration,  but,  untreated,  tends 
"Cure"     in     *°  run  on  indefinitely  till  it  kills  the  patient.    A 
Tuberculo-     cured  case  is  more,  not  less  susceptible  to  a  rein- 
sis,  fection  or  a   relapse  than  before;  hence  many 
doctors  prefer  to  call  the  final  result  "an  arrest" 
rather  than  "a  cure."    As  long  as  the  patient  can  return  safely 
to  work  and  by  wise  living  be  reasonably  sure  of  staying  well 


•       21 

and  workable,  it  makes  little  difference  which  term  we  use  if  he 
is  made  to  understand  the  facts.  t 

When  the  tuberculous  patient  leaves  the  sanatorium,  granted 
his  case  was  discovered  early  and  was  a  light  one,  his  trouble 

is  usually  what  is  called  "arrested."    He  has  lost 

The    danger     all  his  bad  symptoms  and  often  all  symptoms 

time.  whatsoever.     He  has   no   fever   or   fast  pulse, 

weighs  more  than  usual  and  generally  has  no 
cough  or  expectoration. 

This  tempts  him  to  suppose  he  need  take  no  more  care  of 
himself  than  he  did  before  he  was  sick,  a  most  dangerous  idea. 
The  wall  of  scar  tissue  which  shuts  in  the  disease  is  not  fully 
formed  and  will  not  be  for  two  or  three  years,  and  if  he  goes 
home  to  unwise  or  unhygienic  living  conditions  the  symptoms 
he  has  lost  will  slowly  but  surely  return  and  others  with  them, 
and  in  a  year  "the  last  state  of  that  man  will  be  worse  than  the 
first."  Many  foolish  patients,  gifted  by  Nature  with  fine  con- 
stitutions, have  several  such  relapses,  each  followed  by  a  new 
"arrest,"  and  they  are  almost  certain  to  break  down  again  finally 
because  they  do  not  have  the  sense  or  will  power  to  live  wisely 
when  they  leave  off  the  regular  taking  of  the  cure.  When,  how- 
ever, the  patient  has  taken  to  heart  the  lessons  of  the  sanatorium 
or  home  doctor,  or  this  pamphlet,  and  lives  wisely  and  carefully, 
he  can,  slowly  but  surely,  continue  to  gain  strength  and  build  up 
a  strong  wall  of  protective  scar  tissue  around  the  disease,  and 
finally  to  accomplish  that  permanent  arrest,  with  restoration  of 
full  working  efficiency  under  reasonable  methods  of  living,  which 
is  called  a  "cure."  Much  of  the  world's  best  work,  whether 
mental  or  manual,  has  been  done  by  men  who  at  one  time  in  their 
lives  suffered  with  tuberculosis.*  Cure,  then,  is  possible,  but  to 
maintain  it  demands,  not  an  invalid's  life  always  scared  of  a 
relapse,  but  a  constant  intelligent  remembering  of  the  facts 
learned  and  a  denial  of  certain  over-indulgences  both  of  work 
and  of  pleasure  which  medical  science  has  proved  are  not  safe 
for  the  recovered  consumptive. 

Finally,  remember  that  your  getting  well,  however  good  your 
doctor  is,  depends  chiefly  on  yourself,  on  Your  common  sense,  on 

Your  intelligence,  on  Your  determination.    Make 

Your  part  in     up  your  mind  you  will  get  well;  be  willing  to 

the  cure.          deny  yourself  any  pleasure,  however  much  you 

love  it,  if  it  is  harmful ;  be  ready  to  do  anything, 
however  tedious  and  disagreeable,  if  it  be  helpful.  If  you  are 
sick,  fight  bravely  to  be  cheerful  and  bright ;  if  you  are  well  and 


22 

living  with  a  sick  person,  be  sensible  and  do  not  cruelly  make 
him  miserable  by  your  fears,  but  rather  render  him  harmless  to 
you  by  teaching  him  to  carry  out  the  above  rules.  In  this  way 
many  men,  women  and  children  can  be  saved  and  returned  to 
useful  activity,  who  under  the  present  carelessness  as  to  these 
matters  are  doomed  to  death. 

IX.  IF  YOU  OR  YOUR  FAMILY  OR  SOME  ONE  IN 
YOUR  HOUSE  HAS  THE  DISEASE,  WHAT  MUST  BE 
DONE  TO  KEEP  IT  FROM  SPREADING  TO  OTHERS? 

If  proper  and  conscientious  care  is  taken,  there  need  be  no 
danger  to  you  at  all  from  a  consumptive  living  in  the  house  with 
you.    However,  it  takes  eternal  vigilance  on  the 
Disposal     o  f     part  of  a  patient  not  to  transgress  in  these  mat- 
sputum,  ters   and   to   harm   other   people.     The   patient 
should  always  spit  in  a  piece  of  paper,  or  a  paper 
napkin,  which  can  be  burned  up  immediately,  or  put  in  a  box  or 
paper  bag  protected  from  flies,  and  the  whole  burned  up  later. 
Such  papers  should  be  used  but  once,  and  as  they  cost  next  to 
nothing,  the  use  of  a  fresh  one  every  time  will  not  be  expensive. 
The  patient  must  be  careful  not  to  soil  his  hands  from  these 
papers  and  should,  as  has  already  been  stated,  wash  his  hands 
and  mouth  often.     A  regular  cardboard  sputum  box,  or  cup, 
with  a  tin    frame   and   paper   containers   can   be  bought  at  any 
up-to-date  drug  store  for  about  25  cents.     If  this  has  a  lid  to 
keep  the  flies  from  its  contents,  and  if  it  is  filled  with  sawdust 
when  ready  for  burning  and  burned  up  at  once,  it  is  satisfactory. 
If  a  spittoon  must  be  used,  put  into  it  a  quart  of  water  and  a 
tablespoon  of  pure  carbolic  acid  each  morning  and  empty  this 
down  the  water  closet  the  next  mocning.    Where  no  water  closet 
is  available,  bury  it  in  a  hole  in  the  ground  far  from  the  house. 
Such  spittoons,  however,  must  be  cleaned  by  frequent  boiling 
if  they  are  to  be  sanitary.    It  is  most  important  that  the  patient 
cover  his  mouth  with  a  cloth  or  paper  whenever  he  coughs,  and 
such  cloths  or  papers  must  be  burned  after  use.    If,  by  accident, 
any  spit  should  get  on  the  floor,  on  the  clothes  or  on  the  furni- 
ture, pour  over  it  at  once  a  mixture  of  two  tablespoonfuls  of  car- 
bolic acid  (which  is  poison)  in  a  pint  of  hot  water,  and  let  it 
soak  two  hours,  at  least,  and  then  clean  the  place  carefully.    See 
that  the  patient's  cup,  glass,  plate,  knife  and  fork  are  scalded  in 


23 

hot  water  and  washing  soda  and  wiped  dry  after  "use.  His  nap- 
kins, towels,  handkerchiefs,  pillow  cases  and  sheets  must  be  well 
boiled  before  going  to  the  wash.  Avoid  raising  dust  by  sweeping, 
as  this  scatters  the  germs  around.  The  use  of  wet  tea  leaves, 
wet  bits  of  paper  or  wet  sawdust  on  the  floor  before  sweeping 
can  prevent  this  dust.  If  possible,  keep  all  flies  out  of  the  sick 
room,  but  in  any  case  never  let  them  get  at  the  patient's  spit, 
either  in  the  spittoon,  on  papers  or  handkerchiefs,  or  on  his  hands 
or  lips.  If  the  patient  spits  much  the  beard  and  mustache  should 
be  shaved  close,  for  they  will  get  soiled  with  spit. 

The    best    preventive    of    infection    for    those    around    the 

patient  are  healthy  bodies  and  cheerful  minds.    Therefore,  see  to 

it  that  every  one  who  lives  with  a  tuberculous 

Cheerfulness     Patient»  or  especially  with  a  consumptive,  keeps 

a  nd     good     as  we^>  strong  and  cheerful  as  possible.  One  who 

bodily     is  nursing  a  consumptive  should  be  careful  to  get 

health  the     a  brisk  walk  in  the  fresh  air  for  at  least  an  hour 

best   pro-     daily.    In  this  way  there  need  be  absolutely  no 

tection   for     danger  to  any  one  living  with  him,  nor  need  he 

the    family     be  in  Danger  of  reinfecting  himself,  and  it  is 

I'd       m~     entirety  unnecessary  as  well  as  very  cruel  to  treat 

these  patients,  as  is  so  often  done,  as  though 

they  had  smallpox  and  could  infect  you  at  once. 

X.  HOW  MUST  YOU  LIVE  AFTER  YOU  ARE 
APPARENTLY  WELL  AGAIN  SO  AS  TO  REMAIN  WELL? 

The  most  difficult  time  for  the  patient  comes  after  his  doctor, 
or  the  sanatorium,  has  discharged  him,  and  he  begins  to  resume 
his  work  and  his  ordinary  life.  At  this  time  he  has  to  meet  the 
difficult  question  of  a  return  to  active  life  and  to  some  sort  of 
work  by  which  he  can  support  himself  and  his  family.  Whether 
or  not  he  will  remain  well  after  he  goes  back  to  work  rests 
largely  in  his  own  hands  and  depends  on  his  will  power,  his  self- 
control  and  his  common  sense,  and  upon  his  applying  in  his  daily 
life  all  the  knowledge  which  he  has  gained  while  under  treat- 
ment. He  must  never  forget  that  just  as  the  disease  has  taken 
many  years  to  develop  to  the  point  where  it  made  him  sick,  so 
it  will  be  several  years,  even  in  mild  cases,  before  his  lungs  will 
be  entirely  healed. 


i  24 

The  chief  reason  why  patients  become  sick  again  is  because, 
thinking  they  are  just  as  well  as  they  ever  were,  they  are  impru- 
dent  and   neglect    proper    care    of    themselves. 
Why     you     While  you  can  get  well  of  tuberculosis  and  be 
must     be     able  to  do  good,  hard  work,  you  can  never  again 
careful.  risk  putting  an  unlimited  tax  on  your  strength 

regardless  of  the  consequences,  and  must  be 
always  careful  to  think  before  you  act.  On  the  other  hand,  do 
not  go  around  morbidly  dreading  a  return  of  this  disease,  for  a 
cheerful,  hopeful  mental  attitude  is  most  important  for  health. 
Remember,  you  are  not  yet  cured,  but  determine  that  you  will 
accomplish  that  cure.  However  well  you  may  look  or  feel,  the 
longest  part  of  your  cure  lies  ahead  of  you.  Doctors  may  have 
told  you  "your  lungs  are  as  clear  as  a  bell,"  but  even  so,  do  not 
consider  yourself  a  cure.  The  doctor  cannot  always  be  sure 
of  the  condition  of  the  deeper  parts  of  your  lungs,  and  his  failure 
to  find  trouble  at  his  examination  does  not  prove  that  there  can- 
not be  disease  in  the  lung. 

When  you  come  home,  your  family  will  probably  tell  you  that 
you  look  perfectly  well  and  that  you  are  lazy  if  you  do  not  work 
as  hard  as  you  did  or  play  as  hard  as  you  used  to. 
I  m  p  o  rtance     But  do  not  mind  what  they  say,  for  such  advice 
to   the   pa-     is  dangerous.     You  know  how  to  handle  your 
1 1  e  n  t    of     case  much  better  than  they  do,  and  many  patients 
courage     break  down  because  they  let  their  relatives  or 
and  mtelh-     frjen(js  convince  them  that  they  are  able  to  do 
ce'  hard  work  or  harder  play.    Whether  or  not  you 

will  complete  your  cure  successfully  and  get  well, 
depends  largely  on  the  common  sense  and  judgment  you  use  in 
regulating  your  daily  life.  Never  forget  you  have  had  tuber- 
culosis, and  while  not  being  foolishly  anxious,  always  live  twice 
as  carefully  as  you  lived  before.  Many  advanced  cases  have 
gotten  well  by  painstaking  care  of  themselves,  while  many  excel- 
lent early  cases  have  finally  died  as  a  result  of  their  own  cock- 
sureness  and  carelessness.  It  needs  common  sense  and  sand  to 
get  well,  and  you  must  use  both. 

Tuberculosis  is  a  disease  which  tends  to  have  intervals  dur- 
ing which  the  symptoms  are  less  active,  and  other  intervals  when 
the  patient  relapses  and  the  disease  becomes  more 
Return    of     active  again.     This  is  often  called  "grippe"  or 
symptoms,      "just  a  cold,"  but  do  not  be  misled  by  such  com- 
forting names,  but  treat  it  as  a  relapse.     Such 
relapses  can  occur  easily  even  in  the  mildest  cases,  and  must 


25  r 

always  be  considered  as  serious  and  treated  at  once.  They  are 
usually  shown  by  a  rapid  or  steady  falling  off  of  weight,  a  return 
of  an  undue  sense  of  tiredness,  a  beginning  again  of  cough  and 
expectoration,  and  the  reappearance  of  a  little  fever.  "  If  such 
symptoms  appear,  do  not  put  off  doing  something  until  next 
week,  but  go  back  to  absolute,  or  partial,  rest  at  once.  Often  a 
short  period  of  rest  in  bed  will  clear  up  all  these  anxious  symp- 
toms, and  you  will  make  everything  come  out  all  right',  but  do  not 
sit  around  and  do  nothing  hoping  that  all  will  come  out  all  right. 
Neglect  of  these  warning  symptoms  has  been  the  cause  of  many 
relapses  and  deaths. 

As  to  your  home  life,  follow  the  instructions  already  given 
about  your  room  and  general  accommodations,  and  remember 
that  if  you  have  to  work  indoors  all  day  to  sup- 
Home   condi-     Port  yourself  it  is  all  the  more  important  that  you 
tions.  should  have  all  the  fresh  air  possible  out  of  work 

hours  to  make  up  the  difference.  When  one  first 
returns  to  work,  and  may  be  somewhat  overtaxed  by  it,  it  is  wise 
to  spend  all  the  time  out  of  work  hours  resting  in  .the  open  air, 
and  only  when  you  have  determined  that  you  can  do  the  work 
satisfactorily  is  it  safe  to  use  your  hours  at  home  for  exercise 
or  recreation. 

Be  very  careful  in  the  choice  of  your  amusements.    Many  of 

those  we  like  best  are  foolish  or  dangerous.     Stay  away  from 

dances  or  dance  halls,  which  are  always  dusty 

Choice    of     an<^  overheated  and  demand   overexertion,  and 

amuse-     from  "movies,"  which  are  rarely  well  ventilated ; 

ments.  avoid  all  crowded,  close,  dusty  places  where  you 

run  a  big  chance  of  catching  grippe,  which  so 

often  wakes  these  cases  up  again.    Try  to  let  your  amusements 

be  always  in  the  open  air.    Until  you  are  very  well  you  should 

cut  out  all  night  amusements. 

Try  to  see  that  your  workplace  is  sunny  and  airy,  and  above 

all,   not  dusty.     Teach   your  fellow  workmen  what  you   have 

j  learned  about  the  importance  of  fresh  air  and  the 

Your     work-     danger    of    spitting    carelessly.      Keep    regular 

place.  hours  and  always  try  to  get  a  little  rest  after 

eating  before  you  go  back  to  work.     .^ 


26 

As  has  been  already  said,  wash  your  hands  and  mouth  often 
and  be  careful  to  keep  your  teeth  clean  and  in  good  condition. 

If  your  work  proves  hard  and  tiring,  spend  all 

Personal   hy-     Sunday  in  bed  with  your  -windows  open,  and  be 

giene.  careful  not  to  injure  your  family  or  friends  by 

carelessness  at  such  times  as  they  are  around 
you.  Go  to  bed  early  and  always  try  to  get  at  least  eight  hours 
sleep.  Take  at  least  one  warm  bath  in  the  week,  and,  if  you  are 
used  to  them  and  they  help  you,  a  cold  sponge  every  morning. 
Do  not  let  yourself  become  constipated,  but  do  not  get  into  the 
habit  of  taking  strong  medicines. 

XL  WHAT  WORK  MAY  ONE  DO  AFTER  THE  DIS- 
EASE HAS  BEEN  THOROUGHLY  ARRESTED? 

In  the  majority  of  cases  it  is  better  for  the  patient  to  take 
up  the  same  work  he  was  doing  before  he  broke  down,  unless  it 
is  very  dusty  or  damp,  or  exposes  him  to  irri- 
Your  old  job     tating  gases  or  to  severe  physical  strain,  or  unless 
usually  the     it  is  one  whose  conditions  caused  his  first  break- 
best,  down.    If  you  will  take  the  best  care  you  can  of 
the  fourteen  or  sixteen  hours  you  are  not  at 
work,  the  other  eight  or  ten  will  take  care  of  themselves,  pro- 
vided the  place  where  you  work  has  a  reasonable  amount  of  day- 
light, or  better,  sunlight,  and  is  well  ventilated.     Take  all  the 
rest  you  can  during  the  lunch  hour  and  rest  when  you  get  home 
in  the  evening.    Try  to  avoid  rushing  from  your  eating  to  your 
work,  letting  a  short  period  of  quiet  rest  intervene,  and  if  you 
find  yourself  getting  very  tired  at  your  work,  drink  a  milkshake 
in  the  middle  of  the  morning  and  the  afternoon.     It  will  bring 
you  to  the  end  of  your  day  less  tired  and  feeling  much  better. 

Do  not  look  for  a  "light  job  on  the  farm."    There  are  none 
such.    An  indoor  job  you  are  used  to,  unless  it  is  very  unhealthy, 
means,  despite  certain  disadvantages,  less  expo- 
Difficulty     of     sure,   less   physical   and  mental   exertion,   more 
finding     regular  hours  and  better  wages,  and  will  allow 
light  out-     you  to  get  better  home  conditions.     Therefore, 
door  work,     if  you  can,  go  back  to  your  old  work,  but  when 
1  you  are  off  duty  devote  your  entire  time  to  the 

rest  cure  for  at  least  the  first  year,  and  longer  if  your  case  was 
an  advanced  one.  Very  possibly  it  was  not  your  work,  but  what 
you  did  in  your 'fourteen  hours  of  leisure  that  was  responsible 
for  your  breakdown.  How  you  spend  these  hours  of  leisure  will 
largely  decide  whether  you  remain  well  or  not. 


27 

'V 

XII.  HOW  SOON  MAY  ONE  RETURN  TO  WORK 
AFTER  THE  DISEASE  IS  ARRESTED? 

This  is  usually  a  question  of  how  .long  you  can  stay  away 
from  it.  You  should,  if  possible?  have  been  without  active  symp- 
toms, such  as  bad  cough,  free  expectoration,  fever,  sweats,  tired- 
ness, weakness,  shortness  of  breath,  for  at  least  six  months. 
The  earlier  you  have  to  return  to  work,  the  more  careful  you 
must  be.  Do  not  try  to  see  how  much  you  can  do,  but  how 
much  you  can  save  yourself  by  common  sense  and  forethought. 
If  you  can,  start  on  half  time  or  part  time  until  you  have  tried 
yourself  out,  and  then  gradually  increase  it.  A  work  which 
will  break  you  down  if  you  take  it  up  all  at  once  may  often  be 
done  safely  if  you  take  it  up  by  degrees,  doing  a  little  more 
each  week  until  you  work  full  time. 

It  is  important  that  the  doctor  who  will  watch  you  should 
examine  you  at  the  end  of  your  cure,  and  make  a  record  of  his 
findings,  especially  if  you  are  returning  from  a 
Skilful  medi-     sanatorium,  so  that  he  may  know  just  what  your 
cal  supervi-     condition  is  at  that  time,  and  thus  have  a  stand- 
sion.  ard  of  comparison  when  he  re-examines  you  from 

time  to  time.  At  first  let  him  go  over  you  care- 
fully every  month,  then  every  three  months,  and  then  every  six 
months  for  a  long  time. 

Finally,  above  all  things  fight  for  cheei  fulness,  stop  thinking 
of  your  own  woes  and  troubles,  take  an  interest  in  other  people 
and  try  to  help  them,  and  you  will  find  that  the  sunshine  you 
bring  them  will  be  reflected  back  into  your  own  life. 

"Look  up  and  not  down,  look  forward  and  not  backward, 
Look  out  and  not  in,  and  lend  a  hand." 


APPENDIX 


HOW    TO    PREVENT    TUBERCULOSIS    IN    YOUR 
COMMUNITY 

It  is  the  duty  of  every  one  who  has  recovered  from  tuberculo- 
sis, or  who  takes  any  interest  in  those  sick  with  this  disease,  to 
do  all  in  his  power  to  prevent  the  further  spread 
Your  duty  as     of  tuberculosis  in  his  community  and  to  teach 
a  citizen.         others  what  he  has  learned  as  to  its  proper  pre- 
vention and  care.     The  two  chief  ways  in  which 
its  spread  may  be  prevented  are,  first,  through  the  destruction  of 
the  germ ;  and  second,  through  the  raising  of  the  resisting  power 
of  the  individual  to  the  disease.     In  the  community  these  aims 
can  only  be  carried  out  satisfactorily  by  the  central  authorities, 
but  we  all  can  help  to  cultivate  a  strong  public  sentiment  on  the 
subject  and  thus  aid  the  cause.  t. 

The  germ  cannot  be  destroyed  unless  the  authorities  know 
who  has  the  disease  and  who  is  spreading  it  abroad.     There- 
fore, a  proper  registration  law  is  absolutely  nec- 
Report  ing     essary,  as  has  been  proved  in  New  York,  where 
and  regis-     it  was  first  applied  and  where  the  opposition  of 
t  e  r  i  n  g     doctors   to   it,   which   at    first   was   active,   has 
cases.  entirely  ceased.    Try  to  get  such  a  law  in  your 

community.  Only  as  these  cases  are  known  and 
their  surroundings  and  habits  studied  by  visiting  nurses  and 
otherwise,  can  proper  measures  for  their  treatment  and  for  the 
protection  of  others  from  the  danger  be  taken. 

Such  measures  are  the  proper  disinfection  and  cleansing  of 

their  quarters  during  life,  and  especially  after  death.     In  this 

way  the  notorious  "lung  blocks"  of  many  big 

Disinfecting     cities,  where  for  years  every  new  tenant  became 

sick  rooms,     infected  from  the  spit  left  behind  by  previous 

tenants,  have  been  made  safe  and  healthy. 

Laws    against   spitting   cannot   accomplish   much,   but   you 
can  help  to  cultivate  a  proper  public  sentiment  against  careless 
Sanitary     spitting  until  it  is  considered  so  nasty  that  no 
laws.  man  would  wish  to  indulge  in  it. 


29 

<o 

Further,  if  we  are  to  prevent  the  spread  of  this  disease,  we 
must  see  that  the  advanced,  hopeless,  careless  poor  consumptive, 
who  goes  around  spitting  everywhere  and  infect- 
Hospitalsand     mS  ms  family  and  his  neighborhood  by  his  dirty 
other  insti-     habits,  is  so  taken  care  of  by  the  city  or  state,  in 
tutions.  a   proper   and   comfortable   institution,   that   he 

can  be  prevented  from  passing  on  his  trouble 
to  others.  For  this,  proper  hospitals  for  advanced  cases  are 
essential.  To  find  out  the  cases  which  should  be  taken  there, 
as  well  as  other  earlier  and  curable  ones,  needs:  first  dispen- 
saries for  the  examination  and  diagnosis  of  the  cases;  second, 
visiting  nurses  to  visit  the  homes  and  show  the  patients  how  to 
improve  their  conditions;  third,  sanatoria  for  such  of  the  cases 
as  are  curable;  fourth,  open-air  schools  to  strengthen  threat- 
ened children  and  prevent  them  from  developing  the  trouble, 
and  many  other  similar  philanthropic  facilities. 

Every  consumptive  should  be  adequately  supervised  and 
cared  for,  either  in  his  own  home,  if  he  has  the  means,  or  in  a 
dispensary,  sanatorium  or  .hospital  if  he  has  not. 

The  chief  victims  of  tuberculosis  are  the  undernourished, 
ill-fed,  weakened  poor,  and  if  we  are  to  eradicate  this  disease, 
we  must  readjust  and  improve  the  housing,  liv- 
Raising    the     m£    anc^    working   conditions    of    our   working 
r  e  s  i  s  ting     classes  and  of  our  very  poor.    This  is  a  matter 
power      of     for  the  state  and  .for  our  philanthropists,  and 
the  individ-     the  fight  against  tuberculosis  is  in  the  last  analy- 
ual.  Proper     sis    a    philanthropic    and    sociological    problem 
housing     rather  than  a  medical  one.     The  poor  must  be 
conditions,      taught   to   choose   healthy  homes   and  to  keep 
them  clean  when  they  get  them.     Our  landlords 
must  be  taught  to  supply  cheap  but  satisfactory  lodging  places, 
and  not  the  miserable  rookeries  which  yield  such  good  income 
returns  in  dollars  and  such  a  terrible  toll  in  human  life. 
T      ,  .       ,  The  poor  must  be  taught  at  school  and  at 

eac  ing     y-     jlome  to  ^e  more  cleanly  and  to  use  and  to  like 
*  fresh  air,  soap  and  water.  ^ 

They  must  have  available  the  best  possible  food  at  the  cheap- 
est possible  price,  and  their  wives  must  be  taught  how  to  cook 
»       it  decently,  for  the  poor  man  ruins  much  of  his 
Food    and     fo°d  by  bad  cookery,  and  bad  cookery  is  the 
cookery.          foundation    stone   of   much    sickness,   including 
tuberculosis. 


30 

The  children  need  open-air  schools  and  free  lunches  to  build 

them  up  to  resist  the  conditions  to  which  they  are  exposed.    The 

fathers  and  mothers  need  shorter  hours  of  work 

School, Home     and  better  wages;    healthier,  better  ventilated, 

and  Indus-     less  dusty  working  places.     Whatever  improves 

trial      Hy-     the  food  supply  and  offers  a  chance  of  getting 

giene.  clean  and  healthful  milk,  and  improves  the  home 

and  working  conditions  of  the  poor,  will  help  to 

fight  the  disease. 

While  most  of  us  cannot  do  much  on  these  lines,  we  can  all 
of  us  talk  for  better  conditions  and  create  a  strong  public  senti- 
ment in  favor  of  them,  and  when  we  recognize 
Creating  pub-     now  many  human  lives  will  thus  be  saved  yearly, 
lie     senti-     we  can  see  that  it  will  be  fully  worth  while,  and, 
ment.  as  good  citizens,  that  it  is  our  duty  to  push 

every  effort  in  this  direction. 

If  you  would  help  in  the  fight,  you  can  do  it  in  several  ways. 
First,  by  giving  as  much  as  you  can  of  your  money,  time  and 
influence  to  help  the  private  agencies  which  are 
How  can  you     dealing  with  the  tuberculosis  problem,  such  as 
help?  your    local    anti-tuberculosis    organizations    and 

your  local  charitable  societies.  Then  by  helping 
as  a  citizen  and  a  voter  to  secure  adequate  appropriations  for 
your  Board  of  Health  and  for  your  local  sanatoriums,  hospitals 
and  dispensaries.  Second,  by  backing  up  the  public  health  cam- 
paign by  your  talk,  your  interest,  your  action  and  your  influence. 

XIII.  HOW  TO  FIND  OUT  ABOUT  THE  TUBER- 
CULOSIS PROBLEM. 

Some  of  you  who  read  this  pamphlet  will  wish  for  more 
information  on  certain  points.  All  over  the  United  States  are 
state  and  local  anti-tuberculosis  associations,  any  of  which  will 
be  glad  to  answer  your  questions  or  to  help  you  to  the  best  of 
their  ability.  If  you  do  not  know  the  address  of  the  society 
nearest  to  you,  write  to  The  National  Association  for  the  Study 
and  Prevention  of  Tuberculosis,  105  East  Twenty-Second  Street, 
New  York,  or  to  your  State  Board  of  Health,  whose  office  is 
usually  at  your  state  capital.  The  American  Medical  Associa- 
tion, 535  North  Dearborn  Street,  Chicago,  111.,  will  also  be  glad 
to  answer  any  questions,  particularly  about  the  advertised  cures 
for  tuberculosis. 


31 

XIV.  A  FEW  BOOKS  AND  ARTICLES  ON  TUBER- 
CULOSIS. 

The  following  books  and  pamphlets  by  prominent  medical 
authorities  are  reasonable  in  price  and  can  all  be  warmly  recom- 
mended : 

1.  Tuberculosis,  a  Disease  of  the  Masses,  and  How  to  Com- 
bat It.     By  S.  Adolphus  Knopf,  M.D.     Paper  cover,  124  pages. 
Price,  25  cents  postpaid. 

2.  Tuberculosis ;   a   Curable  and   Preventable   Disease.     By 
Lawrence  F.   Flick,  M.D.     Paper  cover,  64  pages.     Price,   15 
cents  postpaid. 

3.  Consumption ;  What  It  Is  and  What  to  Do  About  It.    By 
John  B.  Hawes,  2d,  M.D.     Cloth  bound,  107  pages.     Price,  75 
cents  postpaid. 

4.  Tuberculosis,  the  Great  White  Plague.     By  Edward  O. 
Otis,  M.D.    $1.25  postpaid. 

5.  Rules  for  Recovery  from  Pulmonary  Tuberculosis.     By 
Lawrason  Brown,  M.D. 

•  6.  Hints  and  Helps.    By  Charles  L.  Minor,  M.D.     lOc  post- 
paid. 

Besides  these  excellent  books  by  doctors,  the  two  books  men- 
tioned below  are  by  patients  who  have  had  real  experience  in 
their  fight  with  this  disease.  These  can  be  of  great  help  to  any 
one  who  is  passing  through  a  similar  experience,  and  are 
strongly  recommended: 

7.  T.  B.,  Playing  the  Lone  Game  Consumption.    By  Thomas 
Crawford  Galbreath.    80  pages.    Price,  25  cents  postpaid. 

8.  My  Personal  Experience  with  Tuberculosis.     By  Will  M. 
Ross.    Price,  50  cents  postpaid. 

Valuable  information  as  to  how  to  build  or  arrange  porches, 
bedrooms  or  clothing  for  outdoor  sleeping  can  be  found  in  a 
pamphlet  entitled  "Directions  for  Living  and  Sleeping  in  the 
Open  Air,"  published  by  the  National  Association  for  the  Study 
and  Prevention  of  Tuberculosis.  A  larger  book  of  250  pages, 
profusely  illustrated,  and  giving  many  more  details  than  the 
pamphlet,  is  entitled  "Fresh  Air  and  How  to  Use  It,"  by  Dr. 
Thomas  S.  Carrington,  and  published  oy  the  same  association. 
The  price  of  the  large  book  is  $1 ;  the  pamphlet  will  be  sent  free 
on  receipt  of  a  2-cent  stamp  for  postage. 

Those  interested  in  fighting  tuberculosis,  either  in  their  own 
case  or  in  that  of  those  dear  to  them,  will  find  great  help  by 


32 

systematically  reading  The  Journal  of  the  Outdoor  Life,  the 
Anti-tuberculosis  Magazine,  which  is  the  official  organ  of  The 
National  Association  for  the  Study  and  Prevention  of  Tubercu- 
losis. This  monthly  magazine  has  excellent  articles  on  the 
various  phases  of  taking  the  cure  for  tuberculosis  written  by 
leading  experts,  and  is  invaluable  to  any  one  who  is  interested 
in  the  matter.  The  subscription  price  of  this  journal  is  $1  a  year. 
Any  of  the  books  mentioned  above,  or  The  Journal  of  the 
Outdoor  Life,  may  be  ordered  at  the  prices  mentioned,  from 
the  Journal  of  the  Outdoor  Life  Publishing  Company,  105  East 
Twenty-Second  Street,  New  York  City. 


OVERDUE. 


SEP 

20  1940 
QCT30  1941 


81OLOG 
LIBRARY 


586455 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 


